Deducing Cardiorespiratory Motion of Cardiac Substructures Using a Novel 5D-MRI Workflow for Radiotherapy

Abstract: Objective: Cardiotoxicity is a devastating complication of thoracic radiotherapy. Current radiotherapy imaging protocols are insufficient to decouple and quantify cardiac motion, limiting substructure-specific motion considerations in treatment planning. We propose a 5D-MRI workflow for substructure-specific motion analysis, with future extension to margin calculation. Approach: Our 5D-MRI workflow was implemented for 10 healthy volunteers, ranging from 23 to 65 years old, reconstructing images for end-exhale/inhale and active-exhale/inhale for end-systole/diastole. For motion assessment, proximal coronary arteries, chambers, great vessels, and cardiac valves/nodes were contoured across all images and verified. Centroid/bounding box excursion was calculated for cardiac, respiratory, and hysteresis motion. Distance metrics were tested for statistical independence across substructure pairings. Main Results: 5D-MRI images were successfully acquired and contoured for all volunteers. Cardiac motion was greatest for the coronary arteries (specifically the right coronary) and smallest for the great vessels. Respiratory motion was dominant in the S-I direction and largest for the inferior vena cava. Respiratory hysteresis was generally <5 mm but exceeded 5 mm for some volunteers. For cardiac motion, there were statistical differences between the coronary arteries, chambers, and great vessels, and between the right/left heart. Respiratory motion differed significantly between the base and apex of the heart. Significance: Our 5D-MRI workflow successfully decouples cardiorespiratory motion with one ~5-minute acquisition. Cardiac motion was >5mm for the coronary arteries and chambers, while respiratory motion was >5mm for all substructures. Statistical considerations and inter-patient variability indicate a substructure and patient-specific approach may be needed for PRV assessment.